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ti <br /> v <br /> t NOTE: PULL ALL PE (SEPTIC, WELL, ETC...) NNE COPIES FOR FILE <br /> LAND USE REPORT APP# pq„S <br /> EHD RECEIVED APP.REFERRAL: "/ -D2- COMPLETE & SUBMIT BY V- --0 <br /> DATEDATE <br /> ATTN: C/� <br /> SITE ADDRESS: 5 p� l/U ZZ <br /> In completing the Land Use investigation, draw all Public Health factors on the ex ibit (i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> xx�4xxic�Fie�c4eie�Eieieir4cicicixie9c��Fic�'e3c�'eicXicixiciciciricx�cicicicieic�eieyciciciex�'cxie�c�cicieieieiricic�Ficicic4c�crcicic�k9c�'c*�cieiciric*iricdeicic�'cxicx <br /> Supervisor/Lead Senior Comments: <br /> f�-� vr� .-►� �� -� �Kof�a�-ate ��. <br /> Gad S�-�` -c� J�t�� � S d ”�q^ � �c� • <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />